| NPI | 1902089709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME107985) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 41476) |
| Enumeration Date | 2007-12-14 |
| Last Update Date | 2014-06-04 |